Aims

This analysis aims to investigate the risk of death or subsequent readmission in patients who have had an emergency hospital admission. It will help us understand what factors influence the risk of death or readmission, including determining variability between ICB area. This could help identify where activity might be mitigated through appropriate community services provision.

Methodology

Three patient cohorts are included within this analysis:

Elderly emergency: those 75 or over with an emergency admission.
Frail: those 65 or over with an emergency admission and a frailty score over 5. The frailty score is calculated from ICD-10 diagnoses recorded for admissions during the previous 2 years and using the risk scores in Gilbert et al (2018), Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. The Lancet, 391(10132), pp.1775-1782. (Note these patients are a subset for those in the elderly emergency cohort)
Falls: those 65 or over with an emergency admission related to a fall.

The End of life cohort are not included as by definition they die during their hospital admission.

Survival analysis has been conducted using data from 2022/23 for

Time to death (mortality)
Time to readmission (time to readmission from the first admission for all patients including some that will have died in the year post-admission)
Time to readmission- excluding those who died prior to readmission

Note: Frimley ICB has been removed from the analysis due to missing data.

Mortality

The time from when a patient first had an emergency admission and first entered the cohort until death was calculated. Those who died on the same day as their emergency admission when they first entered the cohort were excluded.

Trends in the percentage of deaths over time

The proportion of patients who die is higher within the elderly emergency and frail cohorts compared to the falls cohort.

Generally the proportion of deaths within either 28 days or 1 year have remained stable over time. A slightly lower percentage of deaths within 1 year is to be expected for those first admitted in 2023/24 as there is not a full year of follow-up and some deaths will have not yet occurred.

Summary of percentage of patients dying within 1 year (2022/23)

	Elderly Emergency	Frail	Falls
Sex
female	158,781 (26.9%)	117,967 (26.9%)	19,996 (21.5%)
male	151,814 (31.7%)	118,018 (30.8%)	14,284 (30.9%)
Age
65-69	N/A	15,214 (16%)	885 (9.6%)
70-74	N/A	23,743 (19.3%)	1,884 (13%)
75-79	65,677 (20.1%)	36,450 (22.9%)	3,848 (16.9%)
80-84	74,262 (25.3%)	45,672 (28.3%)	6,219 (22%)
85-89	83,602 (32.7%)	54,655 (35.2%)	9,195 (27.9%)
90+	87,054 (45.1%)	60,251 (47%)	12,249 (39%)
Ethnicity
Asian/Asian British	6,521 (23.8%)	5,353 (22.2%)	484 (19.3%)
Black/Black British	3,228 (25.2%)	2,521 (24.4%)	229 (19.6%)
Mixed	660 (25%)	572 (24.9%)	64 (21.6%)
Other	3,126 (26.3%)	2,480 (24.6%)	315 (19.9%)
White British	257,148 (29.4%)	194,921 (29.3%)	28,789 (25.2%)
White Other	10,276 (28.1%)	7,922 (27.8%)	1,169 (23.1%)
Unknown	29,636 (28.4%)	22,216 (27.1%)	3,230 (22.4%)
IMD decile
1	26,468 (31.3%)	22,398 (29.6%)	2,898 (25.2%)
2	27,682 (30.9%)	22,692 (29.9%)	3,260 (26%)
3	28,332 (30.1%)	22,496 (29.2%)	3,210 (25.1%)
4	31,182 (30.2%)	23,778 (29.5%)	3,401 (25.3%)
5	32,184 (29.2%)	24,374 (29.1%)	3,488 (24.5%)
6	33,531 (28.8%)	24,890 (28.5%)	3,735 (24.7%)
7	34,270 (28.7%)	25,238 (28.6%)	3,737 (24.7%)
8	33,722 (28.2%)	24,869 (28.4%)	3,611 (23.9%)
9	32,720 (27.5%)	23,706 (27.5%)	3,666 (24.4%)
10	30,504 (27%)	21,544 (27%)	3,274 (23.1%)

Total	310,595 (29.1%)	235,985 (28.7%)	34,280 (24.6%)

Comparing time to death between the cohorts using Kaplan-meier plot (2022/23)

For those first admitted in 2022/23 we considered the time to death from when the person was first admitted. The most recent year 2023/2024 was not used as there has not be sufficient time for those that entered the cohort at the end of this year to have a full year of follow-up time.

The risk of death is highest in the frail cohort, followed by the elderly emergency cohort, with those in the falls cohort have a lowest risk of death.

Kaplan Meier survival plots of time to death (2022/23)

Summary

The risk of death is increased:

with age
in males
with increasing deprivation
in those who are White British, compared to all other those of other ethnicities

There is some variation between ICBs in the risk of death with the lowest risk seen in the North West London ICB area.

ICB	Deaths	No. at risk	Percentage
QRV: NHS North West London ICB	7,111	29,342	24.2
QUY: NHS Bristol, N S'set & S Gloucs ICB	4,839	17,961	26.9
QRL: NHS Hampshire And Isle Of Wight ICB	11,089	41,017	27.0
QMJ: NHS North Central London ICB	4,317	15,633	27.6
QHL: NHS Birmingham And Solihull ICB	6,637	24,002	27.7
QNC: NHS Staffordshire & Stoke-On-Tr ICB	7,241	26,098	27.7
QOX: NHS Bath & NE S'set, S'don & W ICB	5,065	18,290	27.7
QXU: NHS Surrey Heartlands ICB	6,163	22,254	27.7
QU9: NHS Bucks, Oxford & Berkshire W ICB	8,288	29,859	27.8
QK1: NHS Leics, Leic'shire & Rutland ICB	5,317	19,088	27.9
QVV: NHS Dorset ICB	5,914	21,182	27.9
QOC: NHS Shrops, Telford & Wrekin ICB	3,107	11,024	28.2
QJK: NHS Devon ICB	8,178	28,784	28.4
QKS: NHS Kent And Medway ICB	10,551	37,198	28.4
QKK: NHS South East London ICB	6,492	22,696	28.6
QR1: NHS Gloucestershire ICB	3,451	12,067	28.6
QWE: NHS South West London ICB	5,628	19,703	28.6
QMF: NHS North East London ICB	5,715	19,918	28.7
QSL: NHS Somerset ICB	4,231	14,692	28.8
QT6: NHS Cornwall & Isles Of Scilly ICB	3,078	10,670	28.8
QHM: NHS North East & North Cumbria ICB	20,584	70,998	29.0
QWU: NHS Coventry And Warwickshire ICB	5,646	19,453	29.0
QNX: NHS Sussex ICB	11,294	38,875	29.1
QHG: NHS Beds, Luton & Milton Keynes ICB	4,697	16,045	29.3
QUA: NHS Black Country ICB	7,696	26,260	29.3
QM7: NHS Hertfordshire & West Essex ICB	8,321	28,276	29.4
QYG: NHS Cheshire And Merseyside ICB	15,964	54,391	29.4
QJ2: NHS Derby And Derbyshire ICB	6,934	23,505	29.5
QF7: NHS South Yorkshire ICB	8,775	29,424	29.8
QE1: NHS Lancashire & South Cumbria ICB	11,140	37,233	29.9
QPM: NHS Northamptonshire ICB	4,213	14,111	29.9
QH8: NHS Mid And South Essex ICB	7,523	24,890	30.2
QJM: NHS Lincolnshire ICB	5,139	17,010	30.2
QJG: NHS Suffolk & North East Essex ICB	6,913	22,736	30.4
QOQ: NHS Humber And North Yorkshire ICB	11,800	38,865	30.4
QUE: NHS Cambs & Peterborough ICB	5,041	16,461	30.6
QGH: NHS Herefords & Worcestershire ICB	4,909	16,003	30.7
QOP: NHS Greater Manchester ICB	15,127	49,098	30.8
QT1: NHS Nott'ham & Nottinghamshire ICB	6,628	21,522	30.8
QWO: NHS West Yorkshire ICB	12,907	41,047	31.4
QMM: NHS Norfolk And Waveney ICB	7,598	23,897	31.8

Summary

The risk of death is increased:

with age
in males
with increasing deprivation
in those who are White British, compared to all other those of other ethnicities

There is some variation between ICBs in the risk of death, with many of the London ICB areas having a lower risk of death.

ICB	Deaths	No. at risk	Percentage
QT6: NHS Cornwall & Isles Of Scilly ICB	230	1,199	19.2
QMJ: NHS North Central London ICB	503	2,542	19.8
QRV: NHS North West London ICB	848	4,080	20.8
QOX: NHS Bath & NE S'set, S'don & W ICB	544	2,488	21.9
QOC: NHS Shrops, Telford & Wrekin ICB	286	1,294	22.1
QU9: NHS Bucks, Oxford & Berkshire W ICB	843	3,754	22.5
QKS: NHS Kent And Medway ICB	755	3,305	22.8
QWE: NHS South West London ICB	661	2,893	22.8
QNX: NHS Sussex ICB	1,254	5,485	22.9
QRL: NHS Hampshire And Isle Of Wight ICB	1,392	6,056	23.0
QNC: NHS Staffordshire & Stoke-On-Tr ICB	646	2,749	23.5
QXU: NHS Surrey Heartlands ICB	678	2,869	23.6
QKK: NHS South East London ICB	987	4,167	23.7
QVV: NHS Dorset ICB	635	2,659	23.9
QYG: NHS Cheshire And Merseyside ICB	1,609	6,724	23.9
QJK: NHS Devon ICB	770	3,206	24.0
QJ2: NHS Derby And Derbyshire ICB	594	2,467	24.1
QMF: NHS North East London ICB	821	3,392	24.2
QJM: NHS Lincolnshire ICB	508	2,085	24.4
QT1: NHS Nott'ham & Nottinghamshire ICB	648	2,648	24.5
QGH: NHS Herefords & Worcestershire ICB	532	2,160	24.6
QHM: NHS North East & North Cumbria ICB	2,203	8,901	24.8
QUE: NHS Cambs & Peterborough ICB	561	2,257	24.9
QSL: NHS Somerset ICB	467	1,859	25.1
QE1: NHS Lancashire & South Cumbria ICB	1,242	4,929	25.2
QJG: NHS Suffolk & North East Essex ICB	748	2,949	25.4
QM7: NHS Hertfordshire & West Essex ICB	983	3,867	25.4
QPM: NHS Northamptonshire ICB	468	1,844	25.4
QHL: NHS Birmingham And Solihull ICB	714	2,803	25.5
QK1: NHS Leics, Leic'shire & Rutland ICB	599	2,318	25.8
QWU: NHS Coventry And Warwickshire ICB	655	2,539	25.8
QOP: NHS Greater Manchester ICB	1,656	6,383	25.9
QHG: NHS Beds, Luton & Milton Keynes ICB	639	2,427	26.3
QOQ: NHS Humber And North Yorkshire ICB	1,165	4,415	26.4
QWO: NHS West Yorkshire ICB	1,470	5,489	26.8
QMM: NHS Norfolk And Waveney ICB	911	3,380	27.0
QR1: NHS Gloucestershire ICB	414	1,523	27.2
QF7: NHS South Yorkshire ICB	1,016	3,727	27.3
QUA: NHS Black Country ICB	966	3,525	27.4
QUY: NHS Bristol, N S'set & S Gloucs ICB	704	2,573	27.4
QH8: NHS Mid And South Essex ICB	1,046	3,649	28.7

Summary

The risk of death is increased:

with age
in males
with increasing deprivation
in those who are White British, compared to all other those of other ethnicities

There is some variation between ICBs in the risk of death, with the lowest risk of death seen in the North West London ICB area.

ICB	Deaths	No. at risk	Percentage
QRV: NHS North West London ICB	5,721	24,250	23.6
QOX: NHS Bath & NE S'set, S'don & W ICB	3,471	13,075	26.5
QNC: NHS Staffordshire & Stoke-On-Tr ICB	5,512	20,688	26.6
QXU: NHS Surrey Heartlands ICB	4,447	16,721	26.6
QVV: NHS Dorset ICB	4,065	15,111	26.9
QHL: NHS Birmingham And Solihull ICB	5,082	18,771	27.1
QUY: NHS Bristol, N S'set & S Gloucs ICB	3,654	13,473	27.1
QRL: NHS Hampshire And Isle Of Wight ICB	8,134	29,919	27.2
QU9: NHS Bucks, Oxford & Berkshire W ICB	6,232	22,657	27.5
QMJ: NHS North Central London ICB	3,329	12,015	27.7
QK1: NHS Leics, Leic'shire & Rutland ICB	4,007	14,401	27.8
QWE: NHS South West London ICB	4,383	15,728	27.9
QT6: NHS Cornwall & Isles Of Scilly ICB	2,101	7,494	28.0
QKK: NHS South East London ICB	5,318	18,941	28.1
QOC: NHS Shrops, Telford & Wrekin ICB	2,322	8,266	28.1
QSL: NHS Somerset ICB	3,041	10,841	28.1
QHM: NHS North East & North Cumbria ICB	16,130	57,065	28.3
QR1: NHS Gloucestershire ICB	2,432	8,537	28.5
QNX: NHS Sussex ICB	8,312	29,057	28.6
QJK: NHS Devon ICB	5,813	20,270	28.7
QMF: NHS North East London ICB	4,610	16,078	28.7
QYG: NHS Cheshire And Merseyside ICB	12,764	44,434	28.7
QKS: NHS Kent And Medway ICB	7,140	24,797	28.8
QUA: NHS Black Country ICB	6,048	20,990	28.8
QHG: NHS Beds, Luton & Milton Keynes ICB	3,616	12,450	29.0
QF7: NHS South Yorkshire ICB	6,710	22,908	29.3
QJM: NHS Lincolnshire ICB	3,874	13,220	29.3
QM7: NHS Hertfordshire & West Essex ICB	6,252	21,310	29.3
QWU: NHS Coventry And Warwickshire ICB	4,424	15,123	29.3
QJ2: NHS Derby And Derbyshire ICB	5,246	17,797	29.5
QH8: NHS Mid And South Essex ICB	5,806	19,418	29.9
QE1: NHS Lancashire & South Cumbria ICB	8,728	28,924	30.2
QOP: NHS Greater Manchester ICB	11,979	39,638	30.2
QPM: NHS Northamptonshire ICB	3,411	11,307	30.2
QOQ: NHS Humber And North Yorkshire ICB	8,940	29,499	30.3
QWO: NHS West Yorkshire ICB	10,110	33,171	30.5
QT1: NHS Nott'ham & Nottinghamshire ICB	5,140	16,821	30.6
QUE: NHS Cambs & Peterborough ICB	3,899	12,688	30.7
QGH: NHS Herefords & Worcestershire ICB	3,652	11,825	30.9
QJG: NHS Suffolk & North East Essex ICB	5,161	16,517	31.2
QMM: NHS Norfolk And Waveney ICB	5,522	17,639	31.3

Multivariate survival analysis of time to death (2022/23)

For this analysis we have taken only data from 2022-2023, and only the first admission for each patient. We have excluded admissions where the person died on the day of admission.

We have fitted multivariate Cox proportional hazard models to our data to assess how various factors independently affect the risk of readmission occurring over time.

Assumptions of Cox proportional hazards models

Cox proportional hazards models assume that the hazard rate (in this case risk of death) for a person with one set of covariates is proportional to the hazard rate for a person with a different set of covariates, so that the hazard ratio is assumed to be constant over time.

The proportional hazards (PH) assumption can be checked using statistical tests and graphical diagnostics based on the scaled Schoenfeld residuals.

We find significant p-values for some covariates, particularly for ICBs, indicating that the data violates the proportional hazards assumption. This is unsurprising as we have very high number of patients included within our dataset, which means even very small deviations in the residuals over time can result in significant p-values.

Plotting a smoothed fit to the Schoenfeld residuals allows us to determine, where p-values are significant, whether the changes in the beta coefficient over time are large enough to meaningfully impact our analyses. Deviations from a horizontal line indicate non-proportional hazards, and that the hazard ratio will be changing over time.

There are alternatives when the proportional hazards assumption is violated such as adding a time interaction into the model or using an alternative accelerated failure model. With the size of our dataset and the number of covariates (over 40 ICBs) the alternatives do not appear feasible and would unlikely add useful information to our conclusions.

Considering these factors and that for this analysis the degree of variation and trends are more important than the absolute hazard ratios we have used a Cox proportional hazards models, and the calculated hazard ratios can be considered as a time-averaged hazard ratio. We have modelled the risk of death within 28 days and within 1 yr. Considering the first 28 day period alongside the 1 year time period means we can check for any initial differences in the first 28 days that might be averaged out in the long 1 year period. There are some differences in the hazard ratios calculated for the two models, but the general trends are consistent.

Elderly emergency

Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.

              chisq df      p sig
sex         41.2493  1 0.0000   *
age_range  150.1131  1 0.0000   *
ethnicity    0.2715  1 0.6023    
imd_decile   0.0999  1 0.7520    
icb          1.3890  1 0.2386    
GLOBAL     243.3581 59 0.0000   *

              chisq df      p sig
sex         38.1467  1 0.0000   *
age_range  396.9170  1 0.0000   *
ethnicity    0.0115  1 0.9146    
imd_decile   1.6895  1 0.1937    
icb          1.5642  1 0.2111    
GLOBAL     689.5564 59 0.0000   *

Summary

In the elderly emergency cohort the risk of death post-admission:

is higher in males.
increases with increasing age.
up to 28 days those who are Black/Black British or White Other ethnicity have a lower risk of death compared to White British, while Other and Unknown ethnicities have an increased risk. In the 1 year post-admission the risk of death is lower compared to White British for all other ethnicities, apart from Unknown.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) have a higher risk of death than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of death is lowest in the North West London ICB area and highest in the Norfolk and Waveney ICB area.

Falls

              chisq df      p sig
sex          0.0269  1 0.8696    
age_range  400.3599  1 0.0000   *
ethnicity    0.3301  1 0.5656    
imd_decile   0.0387  1 0.8441    
icb         96.5997  1 0.0000   *
GLOBAL      87.4781 61 0.0148   *

               chisq df      p sig
sex           0.3263  1 0.5678    
age_range  1138.7820  1 0.0000   *
ethnicity     0.0002  1 0.9881    
imd_decile    0.0035  1 0.9526    
icb           1.3590  1 0.2437    
GLOBAL      213.6630 61 0.0000   *

Summary

In the falls cohort the risk of death post-admission:

is higher in males.
increases with increasing age.
up to 28 days those who are Asian/Asian British, Black/Black British, Other or Unknown ethnicity have a lower risk of death compared to White British. In the year post-admission the risk of death is lower for those who are Black/Black British or White Other ethnicities compared to White British.
up to 28days is not as clearly correlated with deprivation. However, in the year post-admission risk of death increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) have a higher risk of death than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of death in the year post-admission is lowest in the North West London ICB and North Central London ICB areas, and highest in the Gloucestershire ICB and Mind and South Essex ICB areas. In the 28 days post-admission the risk of readmission is lowest in the South East London ICB area, and highest in the Gloucestershire ICB area.

Frail

               chisq df      p sig
sex          22.3987  1 0.0000   *
age_range  5932.7015  1 0.0000   *
ethnicity     0.0645  1 0.7995    
imd_decile    0.6659  1 0.4145    
icb           0.9446  1 0.3311    
GLOBAL      345.5420 61 0.0000   *

               chisq df      p sig
sex          23.8176  1 0.0000   *
age_range  3445.9465  1 0.0000   *
ethnicity     0.2245  1 0.6356    
imd_decile    0.0106  1 0.9178    
icb           1.5006  1 0.2206    
GLOBAL      528.0278 61 0.0000   *

Summary

In the frail cohort the risk of death post-admission:

is higher in males.
increases with increasing age.
up to 28 days those who are of Unknown ethnicity have a higher risk of death compared to White British. While in the 1 year post-admission the risk of death is lower for those of Asian/Asian British, Black/Black British and Other ethnicities compared to White British.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) have a higher risk of death than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of death in the year post-admission is lowest in the North West London ICB and Dorset ICB areas and highest in the Humber and North Yorkshire ICB and Hereford and Worcestershire ICB areas. In the 28 days post-admission the risk of readmission is lowest in the North West London ICB and Bristol, North Somerset and South Gloucestershire ICB areas, and highest in the Hereford and Worcestershire ICB and Cornwall and Isles of Scilly ICB areas.

Number of deaths on day of admission by ethnicity

For the survival analysis we excluded anyone who died on the day of first admission, so given the differences seen in the risk of death by ethnicity we have checked whether there are differences in the percentage of patients who die on the day of first admission by ethnicity.

Ethnicity	Percentage who die on day of admissions
White British	0.33
Asian/Asian British	0.33
Black/Black British	0.33
Mixed	0.30
Other	0.25
White Other	0.27
Unknown	0.44

The percentage of patient who die on the day of admission is slightly higher for those who are Asian/Asian British and of Unknown ethnicity compared to those who are White British.

Readmissions

Trends in the percentage of admissions with a subsequent readmission over time

Generally the proportion of admissions that have resulted in a readmission within either 28 days or 1 year have remained stable over time.

The proportion of patient with a readmission is higher in the elderly emergency and frail cohorts compared to the falls cohort.

A lower percentage of readmissions within 1 year is to be expected for those admitted in 2023/24 as there is not a full year of follow-up and some readmissions will have not yet occurred.

Summary of percentage of patients readmitted within 1 year (2022/23)

All admissions are counted an individual events, so some patients with multiple admissions will be included more than once.

	Elderly Emergency	Frail	Falls
Sex
female	275,117 (30.6%)	166,668 (29.4%)	21,796 (21.7%)
male	277,615 (36.4%)	173,647 (33.9%)	15,633 (31.2%)
Age
65-69	N/A	22,486 (18.8%)	966 (9.8%)
70-74	N/A	35,020 (22.3%)	2,048 (13.2%)
75-79	122,350 (24.8%)	53,864 (26%)	4,190 (17.1%)
80-84	136,797 (29.8%)	66,343 (31%)	6,819 (22.3%)
85-89	148,913 (36.7%)	78,824 (37.8%)	10,065 (28.1%)
90+	144,672 (47.6%)	83,778 (48.6%)	13,341 (38.8%)
Ethnicity
Asian/Asian British	12,444 (28.2%)	8,031 (25.3%)	526 (19.5%)
Black/Black British	6,225 (29.6%)	3,872 (27.5%)	252 (19.4%)
Mixed	1,239 (29.8%)	858 (28.5%)	73 (22.3%)
Other	5,554 (30.3%)	3,503 (26.8%)	354 (20.3%)
White British	459,853 (33.7%)	281,826 (32.1%)	31,434 (25.4%)
White Other	18,946 (32.4%)	11,678 (30.6%)	1,280 (23%)
Unknown	48,471 (32.4%)	30,547 (29.9%)	3,510 (22.9%)
IMD decile
1	49,177 (35.7%)	32,826 (32.3%)	3,116 (25%)
2	51,303 (35.2%)	33,762 (32.9%)	3,582 (26.1%)
3	52,017 (34.5%)	33,125 (32.2%)	3,558 (25.5%)
4	55,425 (34.3%)	34,205 (32.2%)	3,711 (25.4%)
5	57,084 (33.4%)	34,999 (31.8%)	3,796 (24.7%)
6	59,006 (33%)	35,802 (31.4%)	4,070 (24.9%)
7	59,835 (32.7%)	35,850 (31.3%)	4,050 (24.8%)
8	59,305 (32.4%)	35,482 (31.2%)	3,972 (24.3%)
9	56,965 (31.6%)	33,744 (30.3%)	4,007 (24.7%)
10	52,615 (31%)	30,520 (29.8%)	3,567 (23.4%)

Total	552,732 (33.3%)	340,315 (31.5%)	37,429 (24.8%)

Number of readmissions in 2022/2023

cohort	mean	upper quartile	max
elderly emergency	0.55	1	67
falls	0.08	0	7
frail	0.31	0	36

The majority of patients have no readmission within a year, and of those that do have a readmission it is most common to just have a single readmission. A small number of patients are having more regular emergency admissions; those with a highest rates appear to be often admitted and discharged on the same day.

Comparing time to readmission between the cohorts using Kaplan-meier plots (2022/23)

Survival analysis was conducted where each admission is treated as an independent event. This means some patients who had multiple admissions within 2022/23 will be included multiple times.

Survival analysis was conducted using a patient’s first admission within 2022/23, so only one event is included per patient, even if the patient has multiple admissions over the year.

The risk of readmission is very similar between the elderly emergency and frail cohorts (note the frail cohort is a subset of the elderly emergency cohort). Those in the falls cohort have a lower risk of readmission.

The risk of admissions is increased slightly by a small subset of patients that have multiple readmissions, as the risk of readmission decreases if only the first admission/ readmission is included for each patient.

Kaplan Meier survival plots of time to readmission (2022/23)

For these plots each admission in 2022/23 was treated as an independent event, meaning that some patients who had multiple admissions within 2022/23 will be included multiple times.

Summary

The risk of readmission is higher in those who are:

aged 80-89, compared to those aged 75-79 or 90+.
male
Asian/Asian British or Black/Black British compared to White British
living in a more deprived area

The risk of readmission varies by ICB area, with a lower risk of readmission in the Dorset, Gloucestershire and Cornwall and Isles of Scilly ICB areas and a higher risk in the North West London ICB area.

ICB	Readmissions	No. at risk	Percentage
QR1: NHS Gloucestershire ICB	7,538	17,057	44.2
QT6: NHS Cornwall & Isles Of Scilly ICB	6,612	14,681	45.0
QVV: NHS Dorset ICB	14,623	31,973	45.7
QOC: NHS Shrops, Telford & Wrekin ICB	7,782	16,293	47.8
QGH: NHS Herefords & Worcestershire ICB	11,357	23,706	47.9
QMM: NHS Norfolk And Waveney ICB	16,713	34,847	48.0
QJM: NHS Lincolnshire ICB	12,130	25,241	48.1
QOX: NHS Bath & NE S'set, S'don & W ICB	13,053	27,036	48.3
QJG: NHS Suffolk & North East Essex ICB	16,829	34,195	49.2
QNX: NHS Sussex ICB	28,798	58,172	49.5
QJK: NHS Devon ICB	21,323	42,920	49.7
QE1: NHS Lancashire & South Cumbria ICB	27,931	55,937	49.9
QSL: NHS Somerset ICB	11,022	22,076	49.9
QKS: NHS Kent And Medway ICB	28,752	57,557	50.0
QK1: NHS Leics, Leic'shire & Rutland ICB	14,608	28,846	50.6
QOQ: NHS Humber And North Yorkshire ICB	30,373	59,446	51.1
QT1: NHS Nott'ham & Nottinghamshire ICB	16,915	32,881	51.4
QWO: NHS West Yorkshire ICB	32,617	63,464	51.4
QU9: NHS Bucks, Oxford & Berkshire W ICB	24,114	46,592	51.8
QH8: NHS Mid And South Essex ICB	20,108	38,759	51.9
QM7: NHS Hertfordshire & West Essex ICB	22,898	44,110	51.9
QUY: NHS Bristol, N S'set & S Gloucs ICB	14,302	27,504	52.0
QYG: NHS Cheshire And Merseyside ICB	43,588	83,759	52.0
QOP: NHS Greater Manchester ICB	40,329	76,617	52.6
QMJ: NHS North Central London ICB	12,730	24,146	52.7
QHG: NHS Beds, Luton & Milton Keynes ICB	13,493	25,501	52.9
QRL: NHS Hampshire And Isle Of Wight ICB	33,940	64,205	52.9
QWE: NHS South West London ICB	16,393	30,997	52.9
QWU: NHS Coventry And Warwickshire ICB	16,336	30,824	53.0
QXU: NHS Surrey Heartlands ICB	18,816	35,481	53.0
QUE: NHS Cambs & Peterborough ICB	14,133	26,315	53.7
QJ2: NHS Derby And Derbyshire ICB	20,582	37,959	54.2
QUA: NHS Black Country ICB	22,677	41,709	54.4
QHM: NHS North East & North Cumbria ICB	62,334	114,454	54.5
QNC: NHS Staffordshire & Stoke-On-Tr ICB	22,617	41,333	54.7
QHL: NHS Birmingham And Solihull ICB	21,020	38,199	55.0
QMF: NHS North East London ICB	18,429	32,989	55.9
QF7: NHS South Yorkshire ICB	26,758	47,738	56.1
QKK: NHS South East London ICB	21,158	37,627	56.2
QPM: NHS Northamptonshire ICB	13,206	23,500	56.2
QRV: NHS North West London ICB	28,710	49,403	58.1

Summary

The risk of readmission is higher in those who are:

aged over 75 years.
male
Black/Black British

In this falls cohort there is no clear association between deprivation and risk of readmission.

The risk of readmission varies by ICB area.

ICB	Readmissions	No. at risk	Percentage
QT6: NHS Cornwall & Isles Of Scilly ICB	443	1,252	35.4
QR1: NHS Gloucestershire ICB	572	1,606	35.6
QOC: NHS Shrops, Telford & Wrekin ICB	518	1,344	38.5
QGH: NHS Herefords & Worcestershire ICB	925	2,311	40.0
QJK: NHS Devon ICB	1,380	3,351	41.2
QJM: NHS Lincolnshire ICB	914	2,213	41.3
QK1: NHS Leics, Leic'shire & Rutland ICB	1,024	2,435	42.1
QSL: NHS Somerset ICB	857	1,996	42.9
QMM: NHS Norfolk And Waveney ICB	1,546	3,599	43.0
QOX: NHS Bath & NE S'set, S'don & W ICB	1,169	2,677	43.7
QE1: NHS Lancashire & South Cumbria ICB	2,316	5,263	44.0
QOQ: NHS Humber And North Yorkshire ICB	2,061	4,683	44.0
QVV: NHS Dorset ICB	1,279	2,874	44.5
QJG: NHS Suffolk & North East Essex ICB	1,420	3,170	44.8
QNX: NHS Sussex ICB	2,675	5,928	45.1
QJ2: NHS Derby And Derbyshire ICB	1,171	2,593	45.2
QT1: NHS Nott'ham & Nottinghamshire ICB	1,293	2,831	45.7
QU9: NHS Bucks, Oxford & Berkshire W ICB	1,857	4,040	46.0
QWO: NHS West Yorkshire ICB	2,759	5,867	47.0
QUY: NHS Bristol, N S'set & S Gloucs ICB	1,333	2,800	47.6
QYG: NHS Cheshire And Merseyside ICB	3,414	7,141	47.8
QMJ: NHS North Central London ICB	1,358	2,785	48.8
QKS: NHS Kent And Medway ICB	1,790	3,642	49.1
QOP: NHS Greater Manchester ICB	3,352	6,824	49.1
QM7: NHS Hertfordshire & West Essex ICB	2,077	4,211	49.3
QHM: NHS North East & North Cumbria ICB	4,772	9,638	49.5
QXU: NHS Surrey Heartlands ICB	1,555	3,132	49.6
QUE: NHS Cambs & Peterborough ICB	1,243	2,462	50.5
QHG: NHS Beds, Luton & Milton Keynes ICB	1,363	2,681	50.8
QWU: NHS Coventry And Warwickshire ICB	1,413	2,776	50.9
QH8: NHS Mid And South Essex ICB	2,050	4,017	51.0
QF7: NHS South Yorkshire ICB	2,098	4,060	51.7
QNC: NHS Staffordshire & Stoke-On-Tr ICB	1,523	2,935	51.9
QRL: NHS Hampshire And Isle Of Wight ICB	3,505	6,745	52.0
QUA: NHS Black Country ICB	2,004	3,857	52.0
QWE: NHS South West London ICB	1,666	3,204	52.0
QHL: NHS Birmingham And Solihull ICB	1,585	3,007	52.7
QPM: NHS Northamptonshire ICB	1,085	2,016	53.8
QMF: NHS North East London ICB	2,087	3,864	54.0
QRV: NHS North West London ICB	2,484	4,569	54.4
QKK: NHS South East London ICB	2,702	4,756	56.8

Summary

The risk of readmission is higher in those who are:

aged 75-89 years, with those aged under 75 having the lowest risk of readmission
male
Black/Black British
living in the most deprived areas

The risk of readmission varies by ICB area, with a lower risk of readmission in the Gloucestershire and Cornwall and Isles of Scilly ICB areas and a higher risk in the North West London ICB area.

ICB	Readmissions	No. at risk	Percentage
QR1: NHS Gloucestershire ICB	4,229	10,449	40.5
QT6: NHS Cornwall & Isles Of Scilly ICB	3,715	9,002	41.3
QVV: NHS Dorset ICB	8,213	19,215	42.7
QOC: NHS Shrops, Telford & Wrekin ICB	4,528	10,308	43.9
QJM: NHS Lincolnshire ICB	7,508	16,864	44.5
QGH: NHS Herefords & Worcestershire ICB	6,758	15,078	44.8
QMM: NHS Norfolk And Waveney ICB	9,940	22,141	44.9
QOX: NHS Bath & NE S'set, S'don & W ICB	7,643	16,719	45.7
QJK: NHS Devon ICB	11,802	25,526	46.2
QSL: NHS Somerset ICB	6,411	13,818	46.4
QE1: NHS Lancashire & South Cumbria ICB	17,297	37,117	46.6
QJG: NHS Suffolk & North East Essex ICB	9,961	21,267	46.8
QK1: NHS Leics, Leic'shire & Rutland ICB	8,621	18,422	46.8
QNX: NHS Sussex ICB	17,634	37,642	46.8
QKS: NHS Kent And Medway ICB	15,246	32,496	46.9
QOQ: NHS Humber And North Yorkshire ICB	17,918	37,982	47.2
QT1: NHS Nott'ham & Nottinghamshire ICB	10,601	21,955	48.3
QH8: NHS Mid And South Essex ICB	12,407	25,602	48.5
QU9: NHS Bucks, Oxford & Berkshire W ICB	14,518	29,853	48.6
QWO: NHS West Yorkshire ICB	21,157	43,545	48.6
QHG: NHS Beds, Luton & Milton Keynes ICB	7,893	16,223	48.7
QM7: NHS Hertfordshire & West Essex ICB	13,667	27,985	48.8
QOP: NHS Greater Manchester ICB	25,408	51,928	48.9
QUY: NHS Bristol, N S'set & S Gloucs ICB	8,593	17,524	49.0
QYG: NHS Cheshire And Merseyside ICB	28,657	58,494	49.0
QMJ: NHS North Central London ICB	7,837	15,782	49.7
QWE: NHS South West London ICB	10,510	21,047	49.9
QWU: NHS Coventry And Warwickshire ICB	10,095	20,184	50.0
QXU: NHS Surrey Heartlands ICB	11,267	22,544	50.0
QHM: NHS North East & North Cumbria ICB	38,245	75,965	50.3
QRL: NHS Hampshire And Isle Of Wight ICB	20,006	39,710	50.4
QUA: NHS Black Country ICB	14,083	27,911	50.5
QUE: NHS Cambs & Peterborough ICB	8,632	17,067	50.6
QHL: NHS Birmingham And Solihull ICB	12,592	24,665	51.1
QNC: NHS Staffordshire & Stoke-On-Tr ICB	14,103	27,412	51.4
QJ2: NHS Derby And Derbyshire ICB	12,601	24,212	52.0
QF7: NHS South Yorkshire ICB	15,998	30,700	52.1
QMF: NHS North East London ICB	11,630	22,205	52.4
QKK: NHS South East London ICB	14,170	26,579	53.3
QRV: NHS North West London ICB	17,882	33,377	53.6
QPM: NHS Northamptonshire ICB	8,465	15,729	53.8

Multivariate survival analysis of time to readmission (2022/23)

For this analysis we have taken only data from 2022-2023, and only the first admission/time to readmission for each patient.

We have fitted Cox proportional hazard models to our data to assess how various factors independently affect the risk of readmission occurring over time.

For information on the testing of the proportional hazards assumption see Section 1.5.1.

We have used a Cox proportional hazards models and the calculated hazard ratios can be considered as a time-averaged hazard ratio. We have considered models for readmission within 28 days and within 1 yr. There are some differences between the hazard ratios calculated for the two models, but the general trends are consistent.

Elderly emergency

              chisq df      p sig
sex          0.5985  1 0.4391    
age_range    0.0000  1 0.9997    
ethnicity    0.3326  1 0.5641    
imd_decile   0.1206  1 0.7284    
icb         26.2954  1 0.0000   *
GLOBAL     648.1661 59 0.0000   *

               chisq df      p sig
sex         286.7574  1 0.0000   *
age_range     0.3894  1 0.5326    
ethnicity     0.2177  1 0.6408    
imd_decile    2.6653  1 0.1026    
icb           3.9941  1 0.0457   *
GLOBAL     1147.1447 59 0.0000   *

Summary

In the elderly emergency cohort the risk of readmission:

is higher in males.
is higher in those aged 80-89 years compared to those aged 75-79 years. Up to 28 days the risk of readmission in those aged 90+ is no higher than those aged 75-79 years, but in the full year after admission the risk of readmission is higher in those over 90 years than those aged 75-79 years. This may be influenced by the risk of death being significantly different between those aged 75-79 years and those aged over 90.
is higher in those who are White British, and significantly lower in those who are Asian/Asian British, Black/Black British, Other or Unknown ethnicity. Up to 28 days those of mixed ethnicity have a similar risk of readmission to White British, but in the analysis, but the risk drops below that of White British in the analysis to 1 year.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission is lowest in the Cornwall and Isles of Scilly ICB area. In the year post-admission the risk of readmission is highest in South East London ICB and North West London ICB areas. While up to 28 days post-admission the risk is highest in the North East London ICB area.

Falls

              chisq df      p sig
sex          3.2766  1 0.0703    
age_range   34.8998  1 0.0000   *
ethnicity    0.0642  1 0.8000    
imd_decile   0.3033  1 0.5818    
icb         13.2508  1 0.0003   *
GLOBAL     115.2325 61 0.0000   *

              chisq df      p sig
sex          7.3360  1 0.0068   *
age_range   16.1494  1 0.0001   *
ethnicity    0.0009  1 0.9757    
imd_decile   0.0803  1 0.7769    
icb         18.6529  1 0.0000   *
GLOBAL     109.3210 61 0.0001   *

Summary

In the falls cohort the risk of readmission:

is higher in males.
is higher in those aged over 70 years compared to those aged 60-64 years.
is lower in those of Unknown ethnicity compared to White British. In the analysis to 1 year the risk of readmission is significantly higher in those who are Black/Black British compared to those who are White British.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission in the year post-admission is lowest in the Cornwall and Isles of Scilly ICB and Gloucestershire ICB areas and highest in the South East London ICB and Northamptonshire ICB areas. In the 28 days post-admission the risk of readmission is lowest in the Gloucestershire ICB and Hereford and Worcestershire ICB areas, and highest in the North West London ICB and Staffordshire and Stoke-on-Trent ICB areas.

Frail

              chisq df      p sig
sex          1.5728  1 0.2098    
age_range    1.7869  1 0.1813    
ethnicity    0.3570  1 0.5502    
imd_decile   0.0945  1 0.7585    
icb        104.4060  1 0.0000   *
GLOBAL     532.4705 61 0.0000   *

               chisq df      p sig
sex         158.5625  1 0.0000   *
age_range   436.9416  1 0.0000   *
ethnicity     0.2432  1 0.6219    
imd_decile    3.4745  1 0.0623    
icb           4.6099  1 0.0318   *
GLOBAL     1178.8713 61 0.0000   *

Summary

In the frail cohort the risk of readmission:

is higher in males.
up to 28days age does not significantly influence the risk of readmission.However, in the year post admission the risk of readmission is higher in those aged over 80 years compared to those aged 75-79 years.
is higher in those who are White British, and significantly lower in those who are Asian/Asian British, Other and Unknown ethnicity. Up to 28 days those who are Black/Black British also have a lower risk of readmission compared to White British, but the risk is no longer reduced in the analysis to 1 year.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission in the year post-admission is lowest in the Cornwall and Isles of Scilly ICB and Gloucestershire ICB areas and highest in the South East London ICB and North West London ICB areas. In the 28 days post-admission the risk of readmission is lowest in the Cornwall and Isles of Scilly ICB and Leicester, Leicestershire and Rutland ICB areas, and highest in the Staffordshire and Stoke-on-Trent ICB and North East London ICB areas.

Readmissions- excluding those who died prior to readmission

In the previous analysis of readmissions we see that some of the ICB areas with the lowest readmission rates are those with higher mortality rates. Given that the risk of readmission will be strongly influenced by the mortality rate for this analysis we have excluded all those that died prior to readmission at either 28 days or 1 year. This gives us the risk of readmission for those that survived to the end of the time period of interest, either 28 days or 1 year.

Trends in the percentage of admissions with a subsequent readmission over time

Summary of percentage of patients readmitted within 1 year (2022/23)

All admissions are counted an individual events, so some patients with multiple admissions will be included more than once.

	Elderly Emergency	Frail	Falls
Sex
female	137,552 (18%)	81,461 (16.9%)	11,819 (13%)
male	150,783 (23.7%)	92,944 (21.6%)	9,353 (21.4%)
Age
65-69	N/A	13,823 (12.4%)	665 (7%)
70-74	N/A	20,484 (14.4%)	1,330 (9%)
75-79	70,759 (16%)	30,062 (16.4%)	2,612 (11.4%)
80-84	74,955 (18.9%)	34,796 (19.1%)	4,115 (14.8%)
85-89	76,842 (23%)	38,909 (23.1%)	5,798 (18.4%)
90+	65,779 (29.2%)	36,331 (29.1%)	6,652 (24%)
Ethnicity
Asian/Asian British	7,018 (18.2%)	4,431 (15.7%)	351 (13.9%)
Black/Black British	3,524 (19.2%)	2,179 (17.6%)	178 (14.5%)
Mixed	669 (18.7%)	479 (18.2%)	46 (15.3%)
Other	2,802 (18%)	1,717 (15.2%)	203 (12.8%)
White British	241,639 (21.1%)	145,474 (19.6%)	17,898 (16.2%)
White Other	10,243 (20.6%)	6,141 (18.8%)	773 (15.3%)
Unknown	22,440 (18.1%)	13,984 (16.3%)	1,723 (12.7%)
IMD decile
1	26,455 (23%)	17,160 (20%)	1,834 (16.4%)
2	27,277 (22.4%)	17,521 (20.3%)	2,145 (17.5%)
3	27,735 (21.9%)	17,417 (20%)	2,126 (17%)
4	28,717 (21.3%)	17,295 (19.4%)	2,134 (16.4%)
5	29,722 (20.7%)	17,854 (19.3%)	2,088 (15.3%)
6	30,450 (20.2%)	18,229 (18.9%)	2,263 (15.5%)
7	30,769 (20%)	18,049 (18.7%)	2,203 (15.2%)
8	30,652 (19.9%)	18,040 (18.7%)	2,245 (15.3%)
9	29,339 (19.2%)	17,166 (18.1%)	2,151 (15%)
10	27,219 (18.9%)	15,674 (17.9%)	1,983 (14.5%)

Total	288,335 (20.6%)	174,405 (19.1%)	21,172 (15.8%)

Comparing time to readmission between the cohorts using Kaplan-meier plots (2022/23)

Survival analysis was conducted where each admission is treated as an independent event. This means some patients who had multiple admissions within 2022/23 will be included multiple times.

Survival analysis was conducted using a patient’s first admission within 2022/23, so only one event is included per patient, even if the patient has multiple admissions over the year.

Kaplan Meier survival plots of time to readmission (2022/23)

For these plots each admission in 2022/23 was treated as an independent event, meaning that some patients who had multiple admissions within 2022/23 will be included multiple times.

Summary

The risk of readmission is higher in those who are:

older
male
Black/Black British
living in a more deprived area

The risk of readmission varies by ICB area, with a lower risk of readmission in the Dorset, Gloucestershire and Cornwall and Isles of Scilly ICB areas.

ICB	Readmissions	No. at risk	Percentage
QR1: NHS Gloucestershire ICB	7,536	14,085	53.5
QT6: NHS Cornwall & Isles Of Scilly ICB	6,608	12,168	54.3
QVV: NHS Dorset ICB	14,615	26,857	54.4
QOC: NHS Shrops, Telford & Wrekin ICB	7,780	13,660	57.0
QOX: NHS Bath & NE S'set, S'don & W ICB	13,049	22,715	57.4
QGH: NHS Herefords & Worcestershire ICB	11,353	19,501	58.2
QJM: NHS Lincolnshire ICB	12,121	20,815	58.2
QMM: NHS Norfolk And Waveney ICB	16,707	28,421	58.8
QJK: NHS Devon ICB	21,309	35,933	59.3
QKS: NHS Kent And Medway ICB	28,737	48,345	59.4
QJG: NHS Suffolk & North East Essex ICB	16,823	28,277	59.5
QNX: NHS Sussex ICB	28,783	48,358	59.5
QSL: NHS Somerset ICB	11,011	18,439	59.7
QE1: NHS Lancashire & South Cumbria ICB	27,919	46,422	60.1
QK1: NHS Leics, Leic'shire & Rutland ICB	14,600	24,309	60.1
QU9: NHS Bucks, Oxford & Berkshire W ICB	24,095	39,685	60.7
QUY: NHS Bristol, N S'set & S Gloucs ICB	14,292	23,364	61.2
QOQ: NHS Humber And North Yorkshire ICB	30,354	49,452	61.4
QRL: NHS Hampshire And Isle Of Wight ICB	33,922	54,811	61.9
QMJ: NHS North Central London ICB	12,725	20,531	62.0
QM7: NHS Hertfordshire & West Essex ICB	22,891	36,862	62.1
QT1: NHS Nott'ham & Nottinghamshire ICB	16,909	27,218	62.1
QH8: NHS Mid And South Essex ICB	20,102	32,310	62.2
QYG: NHS Cheshire And Merseyside ICB	43,565	70,074	62.2
QXU: NHS Surrey Heartlands ICB	18,800	30,174	62.3
QWO: NHS West Yorkshire ICB	32,610	52,301	62.4
QWE: NHS South West London ICB	16,387	26,186	62.6
QWU: NHS Coventry And Warwickshire ICB	16,321	25,980	62.8
QHG: NHS Beds, Luton & Milton Keynes ICB	13,487	21,456	62.9
QOP: NHS Greater Manchester ICB	40,307	63,630	63.3
QNC: NHS Staffordshire & Stoke-On-Tr ICB	22,610	35,316	64.0
QHM: NHS North East & North Cumbria ICB	62,301	96,995	64.2
QJ2: NHS Derby And Derbyshire ICB	20,574	32,050	64.2
QUE: NHS Cambs & Peterborough ICB	14,128	22,021	64.2
QUA: NHS Black Country ICB	22,664	35,223	64.3
QHL: NHS Birmingham And Solihull ICB	21,012	32,608	64.4
QMF: NHS North East London ICB	18,425	28,158	65.4
QKK: NHS South East London ICB	21,149	32,186	65.7
QRV: NHS North West London ICB	28,701	43,514	66.0
QPM: NHS Northamptonshire ICB	13,202	19,968	66.1
QF7: NHS South Yorkshire ICB	26,747	40,369	66.3

Summary

The risk of readmission is higher in those who are:

older
male
Black/Black British
living in a more deprived area

The risk of readmission varies by ICB area.

ICB	Readmissions	No. at risk	Percentage
QT6: NHS Cornwall & Isles Of Scilly ICB	443	1,099	40.3
QR1: NHS Gloucestershire ICB	572	1,326	43.1
QOC: NHS Shrops, Telford & Wrekin ICB	518	1,180	43.9
QGH: NHS Herefords & Worcestershire ICB	925	2,005	46.1
QJK: NHS Devon ICB	1,380	2,925	47.2
QJM: NHS Lincolnshire ICB	914	1,928	47.4
QK1: NHS Leics, Leic'shire & Rutland ICB	1,024	2,117	48.4
QSL: NHS Somerset ICB	857	1,752	48.9
QOX: NHS Bath & NE S'set, S'don & W ICB	1,169	2,381	49.1
QMM: NHS Norfolk And Waveney ICB	1,546	3,116	49.6
QE1: NHS Lancashire & South Cumbria ICB	2,316	4,650	49.8
QVV: NHS Dorset ICB	1,279	2,565	49.9
QOQ: NHS Humber And North Yorkshire ICB	2,058	4,090	50.3
QJG: NHS Suffolk & North East Essex ICB	1,420	2,808	50.6
QJ2: NHS Derby And Derbyshire ICB	1,170	2,297	50.9
QT1: NHS Nott'ham & Nottinghamshire ICB	1,293	2,534	51.0
QU9: NHS Bucks, Oxford & Berkshire W ICB	1,857	3,638	51.0
QNX: NHS Sussex ICB	2,673	5,229	51.1
QMJ: NHS North Central London ICB	1,357	2,556	53.1
QWO: NHS West Yorkshire ICB	2,757	5,162	53.4
QYG: NHS Cheshire And Merseyside ICB	3,413	6,384	53.5
QKS: NHS Kent And Medway ICB	1,790	3,275	54.7
QM7: NHS Hertfordshire & West Essex ICB	2,077	3,785	54.9
QHM: NHS North East & North Cumbria ICB	4,769	8,655	55.1
QOP: NHS Greater Manchester ICB	3,351	6,069	55.2
QXU: NHS Surrey Heartlands ICB	1,555	2,817	55.2
QUY: NHS Bristol, N S'set & S Gloucs ICB	1,333	2,390	55.8
QUE: NHS Cambs & Peterborough ICB	1,243	2,205	56.4
QWU: NHS Coventry And Warwickshire ICB	1,411	2,492	56.6
QWE: NHS South West London ICB	1,665	2,932	56.8
QHG: NHS Beds, Luton & Milton Keynes ICB	1,363	2,397	56.9
QNC: NHS Staffordshire & Stoke-On-Tr ICB	1,523	2,659	57.3
QRL: NHS Hampshire And Isle Of Wight ICB	3,504	6,113	57.3
QH8: NHS Mid And South Essex ICB	2,050	3,545	57.8
QF7: NHS South Yorkshire ICB	2,098	3,610	58.1
QMF: NHS North East London ICB	2,087	3,568	58.5
QUA: NHS Black Country ICB	2,004	3,428	58.5
QHL: NHS Birmingham And Solihull ICB	1,585	2,703	58.6
QRV: NHS North West London ICB	2,484	4,211	59.0
QPM: NHS Northamptonshire ICB	1,085	1,836	59.1
QKK: NHS South East London ICB	2,701	4,393	61.5

Summary

The risk of readmission is higher in those who are:

older
male
Black/Black British
living in the more deprived areas

The risk of readmission varies by ICB area, with a lower risk of readmission in the Dorset, Gloucestershire and Cornwall and Isles of Scilly ICB areas.

ICB	Readmissions	No. at risk	Percentage
QR1: NHS Gloucestershire ICB	4,228	8,632	49.0
QT6: NHS Cornwall & Isles Of Scilly ICB	3,711	7,478	49.6
QVV: NHS Dorset ICB	8,209	16,329	50.3
QOC: NHS Shrops, Telford & Wrekin ICB	4,528	8,677	52.2
QJM: NHS Lincolnshire ICB	7,503	14,022	53.5
QOX: NHS Bath & NE S'set, S'don & W ICB	7,642	14,207	53.8
QGH: NHS Herefords & Worcestershire ICB	6,756	12,403	54.5
QMM: NHS Norfolk And Waveney ICB	9,939	18,153	54.8
QJK: NHS Devon ICB	11,795	21,430	55.0
QSL: NHS Somerset ICB	6,408	11,654	55.0
QK1: NHS Leics, Leic'shire & Rutland ICB	8,620	15,595	55.3
QKS: NHS Kent And Medway ICB	15,240	27,267	55.9
QNX: NHS Sussex ICB	17,627	31,476	56.0
QE1: NHS Lancashire & South Cumbria ICB	17,292	30,821	56.1
QOQ: NHS Humber And North Yorkshire ICB	17,908	31,735	56.4
QJG: NHS Suffolk & North East Essex ICB	9,957	17,584	56.6
QU9: NHS Bucks, Oxford & Berkshire W ICB	14,508	25,628	56.6
QUY: NHS Bristol, N S'set & S Gloucs ICB	8,589	14,929	57.5
QHG: NHS Beds, Luton & Milton Keynes ICB	7,890	13,670	57.7
QH8: NHS Mid And South Essex ICB	12,405	21,477	57.8
QM7: NHS Hertfordshire & West Essex ICB	13,661	23,592	57.9
QT1: NHS Nott'ham & Nottinghamshire ICB	10,598	18,298	57.9
QXU: NHS Surrey Heartlands ICB	11,263	19,424	58.0
QYG: NHS Cheshire And Merseyside ICB	28,643	49,417	58.0
QMJ: NHS North Central London ICB	7,835	13,474	58.1
QWO: NHS West Yorkshire ICB	21,149	36,388	58.1
QOP: NHS Greater Manchester ICB	25,398	43,396	58.5
QWE: NHS South West London ICB	10,505	17,934	58.6
QRL: NHS Hampshire And Isle Of Wight ICB	19,996	34,051	58.7
QHM: NHS North East & North Cumbria ICB	38,226	64,989	58.8
QWU: NHS Coventry And Warwickshire ICB	10,084	17,073	59.1
QHL: NHS Birmingham And Solihull ICB	12,589	21,220	59.3
QUA: NHS Black Country ICB	14,078	23,726	59.3
QNC: NHS Staffordshire & Stoke-On-Tr ICB	14,100	23,730	59.4
QUE: NHS Cambs & Peterborough ICB	8,631	14,278	60.4
QRV: NHS North West London ICB	17,874	29,550	60.5
QJ2: NHS Derby And Derbyshire ICB	12,595	20,681	60.9
QMF: NHS North East London ICB	11,629	19,004	61.2
QF7: NHS South Yorkshire ICB	15,994	26,096	61.3
QKK: NHS South East London ICB	14,163	22,840	62.0
QPM: NHS Northamptonshire ICB	8,464	13,426	63.0

Multivariate survival analysis of time to readmission (2022/23)

For this analysis we have taken only data from 2022-2023, and only the first admission/time to readmission for each patient.

We have fitted Cox proportional hazard models to our data to assess how various factors independently affect the risk of readmission occurring over time.

For information on the testing of the proportional hazards assumption see Section 1.5.1.

Elderly emergency

              chisq df      p sig
sex          0.1925  1 0.6608    
age_range    0.0028  1 0.9580    
ethnicity    0.3260  1 0.5680    
imd_decile   0.3230  1 0.5698    
icb         20.5807  1 0.0000   *
GLOBAL     657.5789 59 0.0000   *

               chisq df      p sig
sex         166.1685  1 0.0000   *
age_range    90.2829  1 0.0000   *
ethnicity     0.7149  1 0.3978    
imd_decile   15.9585  1 0.0001   *
icb           2.1304  1 0.1444    
GLOBAL     2028.8874 59 0.0000   *

Summary

In the elderly emergency cohort the risk of readmission:

is higher in males.
increases with increasing age
is higher in those who are White British, and significantly lower in those who are Asian/Asian British, Black/Black British, Other or Unknown ethnicity. Up to 28 days those of mixed ethnicity have a similar risk of readmission to White British, but in the analysis, but the risk drops below that of White British in the analysis to 1 year.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission is lowest in the Cornwall and Isles of Scilly ICB ares. In the year post-admission the risk of readmission is highest in South East London ICB and Northamptonshire areas. While up to 28 days post-admission the risk is highest in the North East London ICB and South East London ICB areas.

Falls

              chisq df      p sig
sex          2.8978  1 0.0887    
age_range   46.2675  1 0.0000   *
ethnicity    0.0725  1 0.7877    
imd_decile   0.3218  1 0.5706    
icb         11.3693  1 0.0007   *
GLOBAL     114.7952 61 0.0000   *

              chisq df      p sig
sex          0.5071  1 0.4764    
age_range  580.2587  1 0.0000   *
ethnicity    0.0239  1 0.8770    
imd_decile   0.2608  1 0.6095    
icb          8.2191  1 0.0041   *
GLOBAL     124.2188 61 0.0000   *

Summary

In the falls cohort the risk of readmission:

is higher in males.
is higher in those aged over 70 years compared to those aged 60-64 years.
is lower in those of Unknown ethnicity compared to White British. In the analysis to 1 year post-admission the risk of readmission is also significantly lower in those who are Asian/Asian British or from Other ethnic backgrounds.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission in the year post-admission is lowest in the Cornwall and Isles of Scilly ICB and Gloucestershire ICB areas and highest in the South East London ICB and Northamptonshire ICB areas. In the 28 days post-admission the risk of readmission is lowest in the Leicester, Leicestershire and Rutland ICB and Hereford and Worcestershire ICB areas, and highest in the North West London ICB and Staffordshire and Stoke-on-Trent ICB areas.

Frail

              chisq df      p sig
sex          1.0416  1 0.3074    
age_range    7.0704  1 0.0078   *
ethnicity    0.3923  1 0.5311    
imd_decile   0.2569  1 0.6122    
icb         83.2885  1 0.0000   *
GLOBAL     540.8746 61 0.0000   *

               chisq df      p sig
sex         107.2706  1 0.0000   *
age_range  6702.7256  1 0.0000   *
ethnicity     0.8407  1 0.3592    
imd_decile   14.4995  1 0.0001   *
icb           1.6387  1 0.2005    
GLOBAL     2143.9871 61 0.0000   *

Summary

In the frail cohort the risk of readmission:

is higher in males.
increases with increasing age.
is higher in those who are White British, and significantly lower in those who are Asian/Asian British, Black/Black British, Other and Unknown ethnicity. In the analysis to one year post-admission those who are White Other also have a significantly lower risk of readmission.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission in the year post-admission is lowest in the and Gloucestershire ICB and Cornwall and Isles of Scilly ICB areas and highest in the South East London ICB and Northamptonshire ICB areas. In the 28 days post-admission the risk of readmission is lowest in the Cornwall and Isles of Scilly ICB and Leicester, Leicestershire and Rutland ICB areas, and highest in the Staffordshire and Stoke-on-Trent ICB and North East London ICB areas.

Conclusions

Following an emergency admission the risk of both death, and readmission (in those who do not die within the follow-up period), in all 3 cohorts (elderly emergency, falls or frail) was higher for males, those living in more deprived areas and those who were older at admission.

There was also significant variability in risk of death and readmission between ICB area, even once any differences in the age, ethnicity, sex and deprivation of the areas were accounted for in this analysis.

The risk of death in the year post-admission was lower for those who were Asian/Asian British, Black/Black British or Other ethnicities, compared to White British. There is a general trend towards a higher risk of readmission for those who are White British than those of other ethnicities. In the elderly emergency and frail cohorts the risk of readmission was lower in those who were Asian/Asian British, Black/Black British, Other and Unknown ethnicity. For the falls cohort there are less differences between ethnic groups, but in the 1 year post-admission analysis the risk of readmission is also significantly lower in those who are Asian/Asian British, from Other or Unknown ethnic backgrounds.